Orthodontic treatment in conjunction with distraction osteogenesis and orthognathic surgery for severe facial asymmetry

The present case report describes the combination of orthodontic treatment and two-stage surgery used to treat a 16-year-old female with a severe maxillary occlusal cant and a mandibular deviation. The patient was diagnosed with right temporomandibular joint ankylosis six months after suffering a facial injury at five years of age. A unilateral condylectomy was performed 12 months later. A hybrid functional appliance was used between nine and 16 years of age to prevent deterioration of the maxillary occlusal cant. At 16 years and six months, it was determined that the patient required a combination of surgical and orthodontic treatment, the pre-surgical orthodontic phase of which was completed at 19 years. The surgery was performed in two stages, which involved a Le-Fort 1 procedure to intrude the maxilla in the left molar region and to extrude in the right molar region. Distraction osteogenesis was performed to achieve a lengthening of the right mandibular ramus. The second operation was a unilateral sagittal split ramus osteotomy to achieve a forward and upward rotation of the left hemimandible. As a result, the patient’s facial asymmetry and occlusion significantly improved. The improvements were well maintained and the patient remained stable after one year of retention.